Body mass index trajectory patterns and changes in visceral fat and glucose metabolism before the onset of type 2 diabetes

Abstract

We investigated BMI trajectory patterns before diabetes diagnosis and examined associated changes in visceral adiposity and glucose metabolism. 23,978 non-diabetic Japanese participants (2,789 women) aged 30-64 years were assessed with a mean follow-up of 7.6 years. Diabetes was diagnosed via fasting glucose, HbA_1c, and self-report. Latent-class trajectory analyses were performed to identify BMI trajectories. Longitudinal changes in BMI, visceral adiposity, and glucose metabolism were estimated using mixed models. 1,892 individuals developed diabetes. Three distinct BMI trajectories were identified in adults developing and not developing diabetes, respectively. Among adults developing diabetes, 47.3% were classified as "medium BMI" (n = 895), and had increased mean BMI within the obesity category before diagnosis. The "low BMI" group (38.4%, n = 726) had an initial mean BMI of 21.9 kg/m², and demonstrated small weight gain. The "high BMI" group (n = 271) were severely obese and showed greater increase in BMI until diagnosis. All groups which developed diabetes showed absolute and/or relative increase in visceral fat and impaired β-cell compensation for insulin resistance. All groups not developing diabetes showed measured variables were relatively stable during observation. These data suggest that visceral fat gain may induce β-cell failure in compensation for insulin resistance, resulting in diabetes regardless of obesity level.

Figure 1. Average changes in BMI, visceral and subcutaneous fat, and ratio of visceral to subcutaneous fat from 9 years before diagnosis/last exam by BMI trajectory.

Solid lines in red indicate estimated trajectories for the groups that developed diabetes, while dashed lines in blue indicate trajectories for each group that did not develop diabetes. Square, high BMI; triangle, medium BMI; circle, low BMI.

Figure 2. Average changes in HbA_1c, fasting glucose, HOMA-IR, HOMA-β, ratio of HOMA-β to HOMA-IR, and fasting insulin from 9 years before diagnosis/last exam by BMI trajectory.

Solid lines in red indicate estimated trajectories for the groups that developed diabetes, while dashed lines in blue indicate trajectories for each group that did not develop diabetes. Square, high BMI; triangle, medium BMI; circle, low BMI.